Results of the phase IIa RADICAL trial of the FGFR inhibitor AZD4547 in endocrine resistant breast cancer.

We conducted a phase IIa, multi-centre, open label, single arm study (RADICAL; NCT01791985) of AZD4547 (a potent and selective inhibitor of Fibroblast Growth Factor Receptor (FGFR)-1, 2 and 3 receptor tyrosine kinases) administered with anastrozole or letrozole in estrogen receptor positive metastatic breast cancer patients who had become resistant to aromatase inhibitors. After a safety run-in study to assess safety and tolerability, we recruited 52 patients. The primary endpoint was change in tumour size at 12 weeks, and secondary endpoints were to assess response at 6 weeks, 20 weeks and every 8 weeks thereafter and tolerability of the combined treatment. Two partial responses (PR) and 19 stable disease (SD) patients were observed at the 12-week time point. At 28 weeks, according to centrally reviewed Response Evaluation Criteria in Solid Tumours (RECIST) criteria, five PR and 8 SD patients were observed in 50 assessable cases. Overall, objective response rate (5 PR) was of 10%, meeting the pre-specified endpoint. Fourteen patients discontinued due to adverse events. Eleven patients had retinal pigment epithelial detachments which was asymptomatic and reversible in all but one patient. Exploratory ribonucleic acid sequencing (RNA-Seq) analysis was done on patients' samples: 6 differentially-expressed-genes could distinguish those who benefited from the addition of AZD4547.

A randomized, open-label study of the efficacy and safety of AZD4547 monotherapy versus paclitaxel for the treatment of advanced gastric adenocarcinoma with FGFR2 polysomy or gene amplification.

BACKGROUND: Approximately 5%-10% of gastric cancers have a fibroblast growth factor receptor-2 (FGFR2) gene amplification. AZD4547 is a selective FGFR-1, 2, 3 tyrosine kinase inhibitor with potent preclinical activity in FGFR2 amplified gastric adenocarcinoma SNU16 and SGC083 xenograft models. The randomized phase II SHINE study (NCT01457846) investigated whether AZD4547 improves clinical outcome versus paclitaxel as second-line treatment in patients with advanced gastric adenocarcinoma displaying FGFR2 polysomy or gene amplification detected by fluorescence in situ hybridization. PATIENTS AND METHODS: Patients were randomized 3:2 (FGFR2 gene amplification) or 1:1 (FGFR2 polysomy) to AZD4547 or paclitaxel. Patients received AZD4547 80 mg twice daily, orally, on a 2 weeks on/1 week off schedule of a 21-day cycle or intravenous paclitaxel 80 mg/m2 administered weekly on days 1, 8, and 15 of a 28-day cycle. The primary end point was progression-free survival (PFS). Safety outcomes were assessed and an exploratory biomarker analysis was undertaken. RESULTS: Of 71 patients randomized (AZD4547 n = 41, paclitaxel n = 30), 67 received study treatment (AZD4547 n = 40, paclitaxel n = 27). Among all randomized patients, median PFS was 1.8 months with AZD4547 and 3.5 months with paclitaxel (one-sided P = 0.9581); median follow-up duration for PFS was 1.77 and 2.12 months, respectively. The incidence of adverse events was similar in both treatment arms. Exploratory biomarker analyses revealed marked intratumor heterogeneity of FGFR2 amplification and poor concordance between amplification/polysomy and FGFR2 mRNA expression. CONCLUSIONS: AZD4547 did not significantly improve PFS versus paclitaxel in gastric cancer FGFR2 amplification/polysomy patients. Considerable intratumor heterogeneity for FGFR2 gene amplification and poor concordance between FGFR2 amplification/polysomy and FGFR2 expression indicates the need for alternative predictive biomarker testing. AZD4547 was generally well tolerated.

An examination of serotonin and psychological variables in the relationship between exercise and mental health.

Research has revealed that exercise is effective for reducing symptoms of depression and anxiety. The mechanisms by which these reductions occur, however, have not been widely studied. To examine several potential theories, a prospective, randomized, 7-week exercise intervention was conducted. Untrained participants were randomly assigned to an aerobic exercise group or to a stretching-control group. Participants completed several questionnaires to assess psychological variables, including measures of depression and anxiety, and blood was drawn at pre- and post-test to measure serum serotonin levels. A mixed-design ANOVA revealed that the exercise group had lower levels of depression than the stretching-control group after the intervention. The exercise group also showed a larger percentage decrease in serotonin than the stretching-control group. This reduction in blood serotonin after exercise is similar to the effects of selective serotonin reuptake inhibitors. Additionally, percent change in serotonin was found to partially mediate the relationship between exercise and depression.

Organ weight and serum triglyceride responses of older (80 week) commercial laying hens fed an alfalfa meal molt diet.

Since one of the costs in the commercial egg industry is that of replacement pullets, commercial egg layer managers have opted to induce molt older hens in order to extend their productive life for additional egg laying cycles. Conventional molt induction involves the complete removal of feed for several days. However, this management practice can lead to deleterious physiological responses by the hen and subsequent susceptibility to infection by pathogens. Consequently less stressful molting regimens involving the feeding of low energy diets such as alfalfa have been developed. In this study, 80 week old laying hens that were deprived of feed or fed alfalfa meal during a nine day induced molt. Full fed hens were used as the control. On day 8 serum triglycerides were quantified and on day 9 hens were euthanized and the liver, spleen, heart, intestine, pancreas, ovary, and kidney were collected and weighed. Intestinal weight were highest in the non-molted hens, lower in the hens fed alfalfa, and lower still in the hens deprived of feed. Molted hens exhibited reduced weights of liver, heart, ovary, and pancreas compared to the non-molted hens. Serum triglycerides were highest in the non-molted hens, less in feed deprived hens, and the lowest in alfalfa fed hens. These results suggest that a comparable molt could be achieved with feeding alfalfa meal to 80 week hens compared to feed deprivation.

Immunological cell and serum metabolite response of 60-week-old commercial laying hens to an alfalfa meal molt diet.

The practice of induced molting involves the restriction of light, feed removal and optionally water for 5-14 days. However, there is growing concern regarding feed removal and animal welfare issues. With this in mind, alternative diets have been developed to produce similar molting effects as that of feed deprivation. Alfalfa, which largely consists of insoluble fiber, can be used as a molting diet. In this study, heterophil and lymphocyte counts, serum chemistry, and organ weight parameters were evaluated in hens that were deprived of feed or fed alfalfa during a nine day induced molt. Full-fed hens were used as the control. Blood serum parameters assessed included calcium, magnesium, glucose, total protein, ketone bodies, uric acid, and cholesterol. White blood cells were counted and categorized by cell type. On the ninth day of the trial, the hens were euthanized and the liver, spleen, heart, intestine, pancreas, ovary, oviduct, and kidney were collected and weighed. On day 8 birds molted with alfalfa or by feed deprivation had significantly higher (P<0.05) levels of ketone bodies and cholesterol and lower levels of calcium, and magnesium compared to the full-fed hens while birds molted by feed deprivation exhibited significantly lower levels of uric acid. Birds molted by both methods exhibited significant reductions in ovary, oviduct, liver and pancreas weights and increased spleen weights when compared to the non-molted hens. On days 0, 2, and 6 there were no significant differences (P>0.05) in either heterophil or lymphocyte percentages. However, heterophil percentages were higher in feed withdrawal birds than full-fed birds on day 4 but lymphocyte percentages were higher in full-fed birds compared to feed withdrawal birds. On day 8 of the induced molt lymphocyte percentages were higher from full-fed birds when compared to feed withdrawal birds but no significant differences were detectable for heterophil percentages. Based on reproductive organ weight loss and changes in serum and immunological responses of birds during molt, it appears that alfalfa meal can be an effective molt induction alternative.

A comparison of modelling and imagery in the acquisition and retention of motor skills.

Although many researchers have examined the effects of imagery and/or modelling interventions, it is unclear which of the two interventions is more effective. In two experiments, novice learners assessed over multiple trials of a free weight squat lifting or a stabilometer balancing task were given modelling, imagery, a combination of modelling and imagery, or control interventions. Group differences indicated, in general, that groups receiving modelling (modelling, combination) evidenced a more appropriate form than groups that did not receive modelling (imagery, control). When apparent, these differences were already in place after the first of several interventions. Practical implications are that even a single bout of modelling can have immediate beneficial effects on movement form (Experiments 1 and 2) and outcome (Experiment 1).

Heavy metal contamination in the Taimyr Peninsula, Siberian Arctic.

The Taimyr Peninsula is directly north of the world's largest heavy metal smelting complex (Norilsk, Russia). Despite this proximity, there has been little research to examine the extent of contamination of the Taimyr Peninsula. We analyzed heavy metal concentrations in lichen (Cetraria cucullata), moss (Hylocomium splendens), soils, lake sediment, freshwater fish (Salvelinus alpinus, Lota lota and Coregonus spp.) and collared lemming (Dicrostonyx torquatus) from 13 sites between 30 and 300 km from Norilsk. Element concentrations were low in both C. cucullata and H. splendens, although concentrations of Al, Fe, Cu, Ni and Pb were significantly higher than those in Arctic Alaska, probably due to natural differences in the geochemical environments. Inorganic surface soils had significantly higher concentrations of Cd, Zn, Pb and Mg than inorganic soils at depth, although a lake sediment core from the eastern Taimyr Peninsula indicated no recent enrichment by atmospherically transported elements. Tissue concentrations of heavy metals in fish and lemming were not elevated relative to other Arctic sites. Our results show that the impact of the Norilsk smelting complex is primarily localized rather than regional, and does not extend northward beyond 100 km.

Legal considerations of sleep deprivation among resident physicians.

Medical training in the United States often takes the form of a grueling endurance test in which patients are often those most at risk. This Article discusses sleep deprivation among resident physicians in the United States with an eye towards resolving the problem through legal channels. It analyzes the effects of sleep deprivation on resident physicians, with subsequent discussion of the implications for patient care and medical training. Next, it makes comparisons to medical training in other developed nations, as well as regulations that exist in the airline and trucking industries, where public safety is a principal concern. Furthermore, this Article discusses proposals to mend the dilemmas created by sleep-deprived resident physicians through statutory and regulatory reform, deterrence by way of tort law, and unionization or collective bargaining.

Vitamin and thyroid status in arctic grayling (Thymallus arcticus) exposed to doses of 3,3',4,4'-tetrachlorobiphenyl that induce the phase I enzyme system.

Induction of phase I biotransformation enzymes is recognized as a hallmark response in fish exposed to coplanar PCBs. Depletions of vitamins A and E and disrupted thyroid hormone and glandular structure secondary to this induction have not yet been examined in an arctic fish species. Arctic grayling were exposed to a single oral dose of 0 (control), 10, 100 or 1000 ng 3,3',4,4'-tetrachlorobiphenyl (TCB) g(-1) bodyweight, a contaminant found in most arctic fish. After 30 and 90 days of exposure, TCB concentrations in tissues, hepatic phase I activity (as ethoxyresorufin-O-deethylase (EROD)), plasma and tissue vitamin A and E concentrations, plasma thyroid hormone levels and thyroid glandular structure were examined. Total plasma osmolality, as an indicator of overall fish health was also monitored. TCB recovery in tissues was low and extremely variable, making comparisons between intended dose groups inappropriate. Therefore, correlation analysis between actual recovered TCB concentrations and biochemical responses was employed. Hepatic EROD activity correlated strongly with liver TCB concentrations. Liver concentrations of vitamin A were altered as a function of TCB concentrations and EROD activity, but plasma vitamin A status was not affected. Vitamin E was depleted by TCB accumulation in blood and EROD induction in liver of males only at 90 days postexposure. Thyroid hormones status and glandular structure were not affected by the short duration TCB exposures used in this experiment. TCB concentrations were correlated with an elevation in plasma osmolality. Results from this experiment indicate that the vitamin status and osmoregulation of arctic grayling exposed to TCB can be compromised. Further studies of field populations exposed to this type of contaminant are warranted.

Levels of vaginal secretory leukocyte protease inhibitor are decreased in women with lower reproductive tract infections.

OBJECTIVE: Secretory leukocyte protease inhibitor contributes resistance to primary human immunodeficiency virus infection in the oral cavity. However, the levels of this inhibitor in the genital tract of women with sexually transmitted diseases or vaginitis are not well described. The objective was to determine vaginal inhibitor levels in women with symptomatic and asymptomatic genital infections. STUDY DESIGN: We tested 207 nonpregnant women for Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, Candida species, and bacterial vaginosis by standard methods. A second group of symptom-free pregnant women (N = 231) was also studied. Secretory leukocyte protease inhibitor was measured by enzyme-linked immunosorbent assay, and results were compared by nonparametric methods. RESULTS: Vaginal levels of secretory leukocyte protease inhibitor in both groups were significantly lower in women with any sexually transmitted disease than in those without infection (P<.0001). Patients with bacterial vaginosis and those with bacterial vaginosis with yeast vaginitis also had decreased levels (P<.025). CONCLUSIONS: Levels of secretory leukocyte protease inhibitor in vaginal fluid are decreased in women with lower genital tract infection. This may represent a common mechanism of increasing susceptibility to infection with human immunodeficiency virus.

Aiming routines and their electrocortical concomitants among competitive rifle shooters.

The present study focused on an examination of competitive shooters' aiming process during a rifle shooting task. The barrel movements of the rifle, as detected by a laser system during the last 1000-ms time period preceding the triggering, were recorded from six elite and six pre-elite shooters. Electrocortical slow potentials (SPs) from frontal (Fz), centro-lateral (C3, C4), and occipital (Oz) brain areas were recorded to get an additional insight into the underlying covert processing. The results suggested that the elite shooters did not pull the trigger until they reached a sustained rifle position. In the pre-elite shooters the rifle appeared to be in a less stable position, and their strategy was to take advantage of the first appropriate moment of steadiness without a sustained rifle position so they could pull the trigger. The observed pre-trigger readiness potential (RP) shifts at Fz and Oz were more positive among the elite shooters relative to the pre-elite shooters, reflecting their more pronounced covert effort, rather than increasing preparedness for the trigger pull. The present study lends support for the view that a successful aiming strategy is mainly based on sustained rifle balancing. With regards to the brain slow potentials, it can be concluded that the RP shift does not specifically reflect the preparation for the trigger pull.

Use of the laryngeal mask airway during awake craniotomy for tumor resection.

There is an increasing trend toward performing craniotomy for primary brain tumor excision with local anesthesia. We report the use of the laryngeal mask airway as a part of an anesthetic technique designed for patients requiring awake cortical mapping during brain tumor excision.

Weight control in wrestling: eating disorders or disordered eating?

PURPOSE: Several recent studies have pointed out that the weight loss techniques used by wrestlers to make weight are similar to the behavior of bulimics. The purpose of this study was to determine whether an increased risk of bulimia nervosa existed for a group of junior high and high school wrestlers. METHODS: Wrestlers (N = 85) completed the Eating Disorder Inventory (EDI) once during the season, and once during the off-season. A comparison group of nonwrestlers (N = 75) also completed the questionnaire. RESULTS: No significant differences were found between the number of in-season wrestlers and nonwrestlers classified as "at risk" for bulimia nervosa. Significant differences were revealed, however, between in-season wrestlers and nonwrestlers, and between in-season wrestlers and off-season wrestlers, on the Drive for Thinness subscale. In both cases, significantly more in-season wrestlers scored above the "at risk" cutoff on the subscale. CONCLUSIONS: These results indicate that although in-season wrestlers are more weight conscious than nonwrestlers, these feelings and attitudes are transient. All subjects classified as "at risk" also participated in an interview which followed the format of the Eating Disorder Examination. Interviews with in-season wrestlers revealed that their concerns with weight were due entirely to the demands of wrestling, and did not meet the severity level required for a diagnosis of bulimia nervosa.

Ultrastructure of neuro-spirocyte synapses in the sea anemone Aiptasia pallida (Cnidaria, Anthozoa, Zoantharia).

Using transmission electron microscopy of serially sectioned tentacles from the sea anemone Aiptasia pallida, we located and characterized two types of neuro-spirocyte synapses. Clear vesicles were observed at 10 synapses and dense-cored vesicles at five synapses. The diameters of vesicles at each neuro-spirocyte synapse were averaged; clear vesicles ranged from 49-89 nm in diameter, whereas the dense-cored vesicles ranged from 97-120 nm in diameter. One sequential pair of synapses included a neuro-spirocyte synapse with clear vesicles (81 nm) and a neuro-neuronal synapse with dense-cored vesicles (168 nm). A second synapse on the same cell had dense-cored vesicles (103 nm). An Antho-RFamide-labeled ganglion cell and three different neurites were observed adjacent to spirocytes, but no neuro-spirocyte synapses were present. Many of the spirocytes also were immunoreactive to Antho-RFamide. The presence of sequential neuro-neuro-spirocyte synapses suggests that synaptic modulation may be involved in the neural control of spirocyst discharge. The occurrence of either dense-cored or clear vesicles at neuro-spirocyte synapses suggests that at least two types of neurotransmitter substances control the discharge of spirocysts in sea anemones.

Assessment of changes in coagulation in parturients with preeclampsia using thromboelastography.

BACKGROUND: Preeclampsia is associated with a risk of abnormal hemostasis that occurs most commonly secondary to thrombocytopenia. Thromboelastography measures whole blood coagulation and has been used to manage coagulation defects in obstetric patients. The authors conducted this investigation in a large number of preeclamptic women to assess changes in coagulation using thromboelastography. METHODS: Thromboelastography and platelet counts were performed in 52 healthy pregnant women, 140 mild preeclamptic women, and 114 severe preeclamptic women in active labor using disposable plastic cups and pins and native whole blood. In preeclamptic patients with a platelet count <100,000/mm3, conventional coagulation tests were also performed. Epidural analgesia was provided in some women when they requested pain relief. RESULTS: Fifteen percent of all preeclamptic women (38 of 254) and 2% (1 of 52) of healthy pregnant women had a platelet count <100,000/mm3. The incidence of thrombocytopenia <100,000/mm3 was 3% (4 of 140) and 30% (34 of 114) in mild preeclamptic patients and severe preeclamptic patients, respectively. Severe preeclamptic patients with a platelet count <100,000/mm3 were significantly hypocoagulable when compared to the other study groups. Ten severe preeclamptic women with a platelet count <100,000/mm3 had a maximum amplitude <54 mm (the lower limit of maximum amplitude in healthy pregnant women enrolled in this investigation). None of the mild preeclamptic women had a maximum amplitude <54 mm. Five severe preeclamptic women with a platelet count <100,000/mm3 had an abnormal coagulation profile, whereas all four mild preeclamptic women with a platelet count <100,000/mm3 had a normal coagulation profile. CONCLUSION: This study shows that severe preeclamptic women with a platelet count <100,000/mm3 are hypocoagulable when compared to healthy pregnant women and other preeclamptic women.